DIALECTICALLY INTEGRATED PSYCHOTHERAPY

A nonfiction book seeks to build a single, coherent model of psychotherapy out of the principal competing approaches.

Hingley astutely observes that the state of psychotherapy today is fractured. There are five main therapeutic approaches—attachment, humanistic, psychodynamic, cognitive, and behavioral theories—often understood to be mutually exclusive, a bar to theoretical or practical unanimity. But she argues that such a coherence is possible under the aegis of “dialectically integrated psychotherapy.” While she acknowledges the contradictions between these theories at great length, the author avers that, in the spirit of philosophical pragmatism, one can choose what works among the different models: “In situations such as this we are in a position of choosing to accept some aspects of a theoretical perspective whilst rejecting others. It is this ability to discriminate between different components of a theoretical approach that is crucial to theoretical integration, and it is essential that we feel free to do so.” At the heart of her theoretical unification is the conception of a unified mind—one “in which all psychological mechanisms and processes are working together in synchrony and unified harmony.” The philosophical bedrock of Hingley’s détente between rival theories is the critical realism of British philosopher Roy Bhaskar, which permits the inclusion of empirical and unobservable data and the coexistence of diverse epistemologies, avoiding the demand for absolute authority in favor of a more pluralistic permissiveness. With an impressively scrupulous attention to detail, the author discusses the prevailing theories and the manner in which they can happily coexist under a single umbrella.

Hingley correctly prioritizes psychotherapy’s philosophical underpinnings and the ways in which theory deeply influences practice. In particular, her discussion of the “epistemological straitjacket of logical positivism” is rigorously rendered, as is her refusal to acquiesce to the relativizing tendencies of postmodern thought. The author lucidly articulates a grave problem for psychotherapy: the absence of both an overarching reflection on the relationship of the mind to reality and a serious consideration of the nature of consciousness. Moreover, her depiction of the theoretical approaches is precise and surprisingly accessible. Unfortunately, her explorations of the philosophical stakes lean toward reductionism. Her reference to the dialectic signals her concern with the possibility of logically synthesizing disparate theoretical elements in the manner proposed by Hegel. But she provides little evidence that she understands Hegel’s philosophy, and her own version of harmonizing incompatibilities bears no meaningful resemblance to his work. What Hingley achieves is not a synthesis of dissimilar elements in the march toward transcending contradictions but a facile eclecticism wherein incompatibility is tolerated in the name of pragmatism. As she puts it, “We need a philosophy that will support us in using a range of epistemologies in complementary ways to study the subject matter of human psychology and psychotherapy the best we can, and in using well thought through criteria to help us make judgments about the knowledge we deem most appropriate…to best support the practice of psychotherapy.” This isn’t dialectical unity—it’s a decision to neglect the possibility that the incompatibilities between theories arise out of the deep contradictions of their worldviews. In addition, the axis that this all rests on is the insistence on a “theoretical unification within the human mind,” a proposal, however plausible, that is more asserted here than demonstrated.

A searching, ambitious, but uneven approach to theoretical synthesis.